Southeast Wellness Lane Corp

LBN: Southeast Wellness Lane Corp
Southeast Wellness Lane Corp is an health care organization with primary practice located at 13265 Sw 39Th St , Davie FL 33330-4748. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as the primary health care specialty. Southeast Wellness Lane Corp can be contacted via phone (786) 493-2293, or through Salas Espinosa, Yuri via phone (786) 493-2293.

Contact Information

Primary practice address
13265 Sw 39Th St Davie FL 33330-4748
Phone: (786) 493-2293
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Salas Espinosa, Yuri Doctor of Medicine (MD)
Phone: (786) 493-2293

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X

Profile Details

NPI number 1962962316
LBN Legal business name Southeast Wellness Lane Corp
DBA Doing business as
Authorized official Salas Espinosa, Yuri Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 21st, 2019
Last updated Mar 21st, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962962316 NPPES
Florida MEDICAID 006456700

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